Neurosurgery Coding Alert

Question: How do we report a T3-T9 thoracic laminectomy for removal of intradural/extramedullary spinal cord mass that is a hematoma? Is code 63271 a correct choice? Please also comment on the choice of codes 63266 and 63281. How far can we consider reporting these codes? Can we also code for the fluoroscopic guidance for localization? Please share your suggestions.

New Hampshire Subscriber

Answer: While most spinal hematomas are extradural, it is possible to have a subdural intraspinal hematoma that prompts surgical excision, as your scenario implies. The code 63271 (Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; thoracic) is the correct choice. The code descriptor clearly mentions ‘excision of intraspinal lesion other than neoplasm.’ The code 63266 (Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; thoracic) also has a similar descriptor but seems inappropriate, as it implies an extradural location of the lesion. Since your surgeon is using an intradural approach, you select code 63271.

Code 63281 (Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, thoracic) is incorrect as it is specific for a neoplasm.

CPT® views 63271 and other codes from this CPT® section as regional codes (i.e., reflecting however many levels are done in any one region, the cervical, thoracic or lumbar), even though there is no specific reference to this interpretation. This means that although your surgeon might address multiple levels, the payer will only pay for one unit of the code since they were all in the thoracic region. However, in the situation where the surgery was extensive and included junctional levels (e.g. T8-L1), you should report 63271 and append modifier 22 (Unusual procedural services) and supply the operative report to convey the additional time and effort spent during the procedure.

In terms of fluoroscopic guidance, 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) is a column 2 code for 63271. Since the fluoroscopy was presumably used for localization, this would be considered a bundled service in 63271 and not separately reportable.